Fellows must demonstrate competence in the performance of thyroid biopsy (bx) from the 2019 ACGME Program Requirements for GME in Endocrinology, Diabetes, and Metabolism. During fellowship, trainees are often taught thyroid bx using an unstructured approach, through demonstration followed by supervised performance on patients. Concerns regarding patient safety, lack of readily available faculty & patients, and lack of competency checkpoints limit the utility of such an approach to teaching procedural skills (1). Application of Psychomotor Learning Theory to teaching procedural skills has modified prior philosophy to “learn, see, practice, prove, do, maintain.” (2) Two phases exist: 1) cognitive- conceptualization and visualization of the procedure and 2) psychomotor- acquisition of procedural skills. Formal training has been shown to improve FNA diagnostic accuracy along with fewer surgical procedures for benign lesions.(2) There is no evidence to support any specific recommendations for training fellows on safe and efficient thyroid bx techniques further highlighting the need for a competency based approach.(3) Since the didactic lecture format is not well suited for the acquisition of complex manual operations, in our study, we seek to 1) create, implement, and standardize the thyroid FNA curriculum for Endocrine fellows at our institution by employing global learning objectives and a skill checklist to help guide competency, and 2) assess the impact of this curriculum on knowledge, performance, and comfort. The goal is to prepare fellows for unsupervised practice through clinical procedure assessment tools to guide practical learning in conjunction with didactic lectures. Curriculum could be implemented not only across the nation to other endocrine fellowships but widely across multiple disciplines such as otolarynology, radiology, pathology. To assess the nationwide need for a formal means of teaching and evaluating thyroid US/ FNA skills within fellowship programs, we will be administering a nationwide survey to all Endocrinology Program Directors and recently graduated Endocrinology Fellows.
1.Vogelgesang, S. A., Karplus, T. M., Kreiter, C. D. (2002). An instructional program to facilitate teaching joint/soft-tissue injection and aspiration. Journal of general internal medicine, 17(6), 441–445.
2. Ljung, B., Drejet, A., Chiampi, N., Jeffrey, J., Goodson, W. H., Chew, K, Miller, T. R. (2001). Diagnostic accuracy of fine-needle aspiration biopsy is determined by physician training in sampling technique. Cancer, 93(4), 263-268. doi:10.1002/cncr.9040.
3. Pitman, B., Abele, J., Ali, S. Z., Elsheikh, T. M., Jeffrey, R. B., Scoutt, L. (2008). Techniques for thyroid FNA: A synopsis of the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference. Diagnostic Cytopathology Diagn. Cytopathol., 36(6), 407-424. doi:10.1002/dc.20829.